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Epstein–Barr virus and the nervous system
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Alexandros C. Tselis, Kumar Rajamani, Pratik Bhattacharya
The classical cranial nerve palsy associated with EBV infection is Bell’s palsy. In three cases of young adults with infectious mononucleosis, diagnosed serologically, unilateral peripheral facial palsy was noted [50]. Bell’s palsy in very young children has also been reported in association with infectious mononucleosis [51]. In several of these patients, the Bell’s palsy was the presenting and sole symptom of infectious mononucleosis, and the findings of lymphadenopathy and splenomegaly led to blood studies that confirmed the diagnosis. Bell’s palsy can be bilateral. In one case, a facial diplegia occurred 2 weeks after clinical infectious mononucleosis, with fever, malaise, and cervical lymphadenopathy [52]. Bell’s palsy can occur with the involvement of other cranial nerves. In one patient, clinical infectious mononucleosis was followed by left-side deafness and then by left-side Bell’s palsy. Examination revealed left facial numbness as well, so this patient had involvement of the left Vth, VIIth, and VIIIth nerves. Nine months later, the patient had recovered completely [53]. Deafness has been reported in association with lymphocytic aseptic meningitis due to EBV which improved with steroids [54]. Hypoglossal nerve palsy was reported in a patient 6 days after the onset of febrile pharyngitis and malaise and was diagnosed by a heterophile antibody test [55]. Other cranial palsies have been reported to occur with infectious mononucleosis.
History Stations
Published in Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox, ENT OSCEs: A Guide to Passing the DO-HNS and MRCS (ENT) OSCE, 2019
Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox
In the absence of an obvious diagnosis it is appropriate to make an initial diagnosis of Bell’s palsy. A 7- to 10-day reducing dose of corticosteroid improves prognosis. Antivirals have not been shown to improve recovery but are still used by many clinicians.
Examine the cranial nerves
Published in Hani TS Benamer, Neurology for MRCP PACES, 2019
Q:How would you investigate? This depends on the possible cause. No investigation is needed in Bell’s palsy. Brain MRI for central lesion. NCS/EMG if Guillain–Barré syndrome is suspected.
Objective assessment of eyelid position and tear meniscus in facial nerve palsy
Published in Orbit, 2022
Alicia Galindo-Ferreiro, Victoria Marqués-Fernández, Hortensia Sanchez-Tocino, Silvana A. Schellini
The seventh cranial nerve, called the facial nerve, controls the muscles for facial expression. Bell’s palsy (BP) is an idiopathic, unilateral, acute weakness of the facial muscles in a pattern consistent with peripheral facial nerve dysfunction resulting in blink dysfunction, malposition of the eyelids such as lower lid ectropion, upper lid retraction, decreased tear production, and a defective tear pump lacrimal drainage mechanism.1Concurring with facial nerve palsy (FNP), the altered position of the lids associated with lower lid laxity can commonly lead to exposure keratopathy, dry eye, and tearing.2 However, there are few studies that objectively evaluate eyelid malposition, with quantitative measurements of margin reflex distance to the upper (MRD1) or to the lower (MRD2) lid in patients with FNP.2,3 Additionally, there are no studies that measure these changes over time.
Challenges and Opportunities for COVID-19 Vaccines in Patients with Cancer
Published in Cancer Investigation, 2021
Nicole M. Kuderer, Joshua A. Hill, Paul A. Carpenter, Gary H. Lyman
The most common adverse reactions reported were injection site reactions (84%), fatigue (63%), headache (55%), muscle pain (38%), chills (32%), joint pain (24%), and fever (14%). Severe adverse reactions were more frequent after Dose 2 than after dose 1 but were less frequent in participants ≥55 years of age compared to younger participants. Four cases of Bell’s palsy were reported in the vaccine group and none in controls. The frequency of serious adverse events overall was <0.5% with the safety profile of BNT162b2 similar across age groups, genders, ethnic and racial groups, and participants with selected medical comorbidities (Table 1). Efficacy outcomes were similar across demographic subgroups including patients of color with the potential exceptions of the cancer survivors with early reports of only 70–80% efficacy. Limited data suggests that those with previous SARS-CoV-2 infection also may benefit from vaccination. There are insufficient data concerning the safety and efficacy of the vaccine in children <16 years of age, pregnant and lactating individuals, and immunocompromised individuals.
Computer vision technology-based face mirroring system providing mirror therapy for Bell’s palsy patients
Published in Disability and Rehabilitation, 2020
Li Ding, Li Li, Zhimin Xu, Jing Tian, Shugeng Chen, Hewei Wang, Ming Yang, Xiao Cui, Lianying Cao, Jie Jia
Bell’s palsy (BP) engenders idiopathic paralysis, which is the most common cause of unilateral peripheral facial weakness [1]. The weakness generally spontaneously recovers within 6 months, but approximately 30% of patients without appropriate treatments may suffer from permanent facial disfigurement [2]. Regardless of the poor prognosis, even temporary deficit would affect physical and psychological health and emotional expression of patients during the repair process. Facial exercise, like mime therapy, is effective in enhancing facial function and shortening the treatment duration [3]. During the facial exercise, a mirror was used to enable the subjects to observe their movements, and increase their motor control and perception [4–7]. However, this kind of feedback acted as a motor observation which presented visual information during exercises.